Revision Hip and Knee Replacement

Expert care when a joint replacement needs a second operation — and a clear plan for what comes next.

What is revision joint replacement?

Revision joint replacement means replacing some or all of the components of a previous hip or knee implant. It’s sometimes called “re-do” joint replacement — the first operation didn’t last, didn’t work as hoped, or developed a problem that can’t be fixed without going back in.

It’s a more complex undertaking than a first-time replacement. There may be bone loss where the old implant loosened, scar tissue from the previous surgery, and occasionally infection to deal with. Because of that complexity, revision surgery benefits enormously from a surgeon who performs these operations regularly — this is one area of joint replacement where experience genuinely changes outcomes.

Why do joint replacements need revision?

  • Loosening and wear over time — the most common reason. Implants are mechanical devices; after years of use, the bond between implant and bone can weaken or the bearing surfaces can wear.
  • Infection — uncommon but serious. Bacteria can colonize an implant, and because antibiotics alone usually can’t clear it, surgery is typically required.
  • Instability or dislocation (hip) — if the ball repeatedly comes out of the socket, the components may need repositioning or a different implant design.
  • Stiffness or persistent pain (knee) — when a knee replacement never achieved good motion or continues to hurt despite a well-positioned implant, revision may be considered after thorough evaluation.
  • Fracture around the implant — a fall or injury can break the bone around a previously well-functioning joint replacement.
  • Implant breakage or recall (rare) — occasionally a specific device has a known problem that warrants replacement.

How is revision different from a first-time replacement?

Honestly? It’s bigger surgery, and you deserve to hear that plainly.

The operation usually takes longer. Planning is more involved — often including CT imaging to map bone loss and plan the reconstruction before the day of surgery. Standard implants frequently aren’t enough, so revision uses specialized components designed for damaged bone: metal augments that fill defects, sleeves or cones that grip compromised bone, and longer stems that anchor into healthy bone above or below the problem area. Modern revision implants are remarkably good at what they do, but they’re solving a harder problem.

Recovery is typically longer than after a first-time replacement, and the risk profile is higher — which is exactly why surgeon experience matters here more than anywhere else in joint replacement. This is not the operation to have done occasionally.

The workup: figuring out what’s wrong

Revision surgery starts long before the operating room — with detective work. A painful or failing joint replacement gets a thorough evaluation: your history and a careful exam, X-rays and often CT scans, bloodwork, and sometimes aspiration of fluid from the joint to test for infection.

This step matters more than patients realize, because getting the diagnosis right determines the entire treatment. A loose implant and an infected implant can look similar on the outside but require very different operations. Rushing to surgery without a clear diagnosis is how revisions fail — Dr. Sloan’s approach is to be certain about the problem before proposing the solution.

What to expect

  • Before surgery: the full diagnostic workup described above, plus detailed surgical planning. If infection is confirmed, treatment is often staged — first clearing the infection, then reconstructing the joint once it’s gone.
  • Day of surgery: a longer operation than a primary replacement, typically followed by at least an overnight hospital stay for monitoring.
  • Recovery: expect a longer road than the first time around — more protected weight-bearing early on, a longer course of physical therapy, and steady progress measured in months. The goal is the same as always: a stable, pain-free joint you can trust.

A note on complex cases

Some patients arrive having been told their case is “too complex” — severe bone loss, deformity, a prior failed surgery, or an infection someone else didn’t want to take on. Dr. Sloan specializes in complex hip and knee problems, including joint replacement infections and fractures around implants. You don’t need to travel into Boston for this level of care; it’s available close to home at Orthopedic Affiliates and Emerson Health in Concord.

Frequently asked questions

Is revision surgery riskier than the first one?

Yes — honestly, it is. The operation is longer, the bone and soft tissues are more challenging to work with, and complication rates are higher than for first-time replacement. That said, in experienced hands, most revision patients get a stable, functioning joint and meaningful pain relief. The key variable is who’s doing the operation.

How do you know if my implant is loose vs. infected?

That’s exactly what the workup is for. X-rays and CT show loosening and bone loss; bloodwork (like CRP and ESR) screens for inflammation; and aspirating fluid from the joint lets us test directly for bacteria. Sometimes the answer is clear quickly; sometimes it takes the full battery of tests. We don’t guess.

Will I need more than one operation?

Sometimes. If infection is present, the standard approach is staged: one operation to remove the infected implant and clear the infection (often with an antibiotic spacer), then a second operation weeks later to put in the new joint once the infection is gone. For non-infected revisions, a single operation is the norm.

How long does a revision last?

It varies more than with first-time replacements because every revision starts from a different place. Many revision implants last a decade or longer, but the honest answer depends on your bone quality, the reason for the revision, and your activity level. Dr. Sloan will give you his straight assessment for your specific case.

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